Common use of LIMIT ON FUNDING AVAILABLE FOR REIMBURSEMENT Clause in Contracts

LIMIT ON FUNDING AVAILABLE FOR REIMBURSEMENT. CalOptima’s funding shall be limited to the unspent CalOptima Intergovernmental Transfer (“IGT”) dollars allocated for Medical Respite Care approved by the CalOptima Board of Directors. In no event shall the cumulative reimbursement under the CalOptima Medical Respite Program exceed $250,000.00. Reimbursement shall be available for authorized Medical Respite Care for CalOptima Members following the 90-day Whole-Person Care Recuperative Care stay, whether the Member is assigned to CalOptima Direct, to a CalOptima Shared Risk Health Network, to a CalOptima HMO Health Network, or to a CalOptima Physician-Hospital Consortium. Regardless of the quantity or volume of Medical Respite Care services provided by County, in no event will CalOptima's obligations exceed said remaining CalOptima IGT dollars specifically allocated for Medical Respite Care. Post Whole-Person Care Medical Respite Care will be authorized for a maximum of ninety (90) days, which may be extended on a case-by-case basis for up to an additional ninety (90) days per request, subject to CalOptima confirmation of medical necessity; there is no limit to the number of instances in which additional time may be approved, subject to available IGT funds specifically allocated hereunder. T h i s Medical Respite Program is not intended to include, and does not include, Medi-Cal Covered Services that are the financial responsibility of CalOptima or its health networks. Medical Respite Program funding shall not be used to pay for Medi-Cal Covered Services which are the responsibility of CalOptima or any of its health networks. Attachment A, Part XII WPC/HHP Crossover Population HHP Select Services to be provided by WPC Providers for COD/CCN Members I. SCOPE OF WORK--- Service Categories: • Targeted Engagement Services to clients referred by CalOptima • Housing Services (HHP enrolled members only) • Care Coordination Participation (HHP enrolled members only)

LIMIT ON FUNDING AVAILABLE FOR REIMBURSEMENT. CalOptima’s funding shall be limited to the unspent CalOptima Intergovernmental Transfer (“IGT”) dollars allocated for Medical Respite Care approved by the CalOptima Board of Directors. In no event shall the cumulative reimbursement under the CalOptima Medical Respite Program exceed $250,000.00. Reimbursement shall be available for authorized Medical Respite Care for CalOptima Members following the 90-day Whole-Person Care Recuperative Care stay, whether the Member is assigned to CalOptima Direct, to a CalOptima Shared Risk Health Network, to a CalOptima HMO Health Network, or to a CalOptima Physician-Hospital Consortium. Regardless of the quantity or volume of Medical Respite Care services provided by County, in no event will CalOptima's obligations exceed said remaining CalOptima IGT dollars specifically allocated for Medical Respite Care. Post Whole-Person Care Medical Respite Care will be authorized for a maximum of ninety (90) days, which may be extended on a case-by-case basis for up to an additional ninety (90) days per request, subject to CalOptima confirmation of medical necessity; there is no limit to the number of instances in which additional time may be approved, subject to available IGT funds specifically allocated hereunder. T h i s his Medical Respite Program is not intended to include, and does not include, Medi-Cal Covered Services that are the financial responsibility of CalOptima or its health networks. Medical Respite Program funding shall not be used to pay for Medi-Cal Covered Services which are the responsibility of CalOptima or any of its health networks. Attachment A, Part XII WPC/HHP Crossover Population HHP Select Services to be provided by WPC Providers for COD/CCN Members I. SCOPE OF WORK--- Service Categories: • Targeted Engagement Services to clients referred by CalOptima • Housing Services (HHP enrolled members only) • Care Coordination Participation (HHP enrolled members only)

LIMIT ON FUNDING AVAILABLE FOR REIMBURSEMENT. CalOptima’s funding shall be limited to the unspent CalOptima Intergovernmental Transfer (“IGT”) dollars allocated for Medical Respite Care approved by the CalOptima Board of Directors. In no event shall the cumulative reimbursement under the CalOptima Medical Respite Program exceed $250,000.00. Reimbursement shall be available for authorized Medical Respite Care for CalOptima Members following the 90-day Whole-Person Care Recuperative Care stay, whether the Member is assigned to CalOptima Direct, to a CalOptima Shared Risk Health Network, to a CalOptima HMO Health Network, or to a CalOptima Physician-Physician- Hospital Consortium. Regardless of the quantity or volume of Medical Respite Care services provided by County, in no event will CalOptima's obligations exceed said remaining CalOptima IGT dollars specifically allocated for Medical Respite Care. Post Whole-Person Care Medical Respite Care will be authorized for a maximum of ninety (90) days, which may be extended on a case-by-case basis for up to an additional ninety (90) days per request, subject to CalOptima confirmation of medical necessity; there is no limit to the number of instances in which additional time may be approved, subject to available IGT funds specifically allocated hereunder. T h i s Medical Respite Program is not intended to include, and does not include, Medi-Cal Covered Services that are the financial responsibility of CalOptima or its health networks. Medical Respite Program funding shall not be used to pay for Medi-Cal Covered Services which are the responsibility of CalOptima or any of its health networks. Y. Attachment A, Part XII WPC/HHP Crossover Population HHP Select Services to be provided by WPC Providers for COD/CCN Members I. SCOPE OF WORK--- Service Categories: • Targeted Engagement Services to clients referred by CalOptima • Housing Services (HHP enrolled members only) • Care Coordination Participation (HHP enrolled members only)

LIMIT ON FUNDING AVAILABLE FOR REIMBURSEMENT. CalOptima’s funding shall be limited to the unspent CalOptima Intergovernmental Transfer (“IGT”) dollars allocated for Medical Respite Care approved by the CalOptima Board of Directors. In no event shall the cumulative reimbursement under the CalOptima Medical Respite Program exceed $250,000.00. Reimbursement shall be available for authorized Medical Respite Care for CalOptima Members following the 90-day Whole-Person Care Recuperative Care stay, whether the Member is assigned to CalOptima Direct, to a CalOptima Shared Risk Health Network, to a CalOptima HMO Health Network, or to a CalOptima Physician-Hospital Consortium. Regardless of the quantity or volume of Medical Respite Care services provided by County, in no event will CalOptima's obligations exceed said remaining CalOptima IGT dollars specifically allocated for Medical Respite Care. Post Whole-Person Care Medical Respite Care will be authorized for a maximum of ninety (90) days, which may be extended on a case-by-case basis for up to an additional ninety (90) days per request, subject to CalOptima confirmation of medical necessity; there is no limit to the number of instances in which additional time may be approved, subject to available IGT funds specifically allocated hereunder. T h i s Medical Respite Program is not intended to include, and does not include, Medi-Cal Covered Services that are the financial responsibility of CalOptima or its health networks. Medical Respite Program funding shall not be used to pay for Medi-Cal Covered Services which are the responsibility of CalOptima or any of its health networks. Attachment A, Part XII WPC/HHP Crossover Population HHP Select Services to be provided by WPC Providers for COD/CCN Members I. SCOPE OF WORK--- Service Categories: • Targeted Engagement Services to clients referred by CalOptima • Housing Services (HHP enrolled members only) • Care Coordination Participation (HHP enrolled members only)ATTACHMENT B – AMENDMENT 5